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Radiotherapy given straight after prostate surgery kept the PSA down for longer, but over ten years that did not translate into fewer men whose disease actually progressed, and side effects were commoner.
EORTC 22911 randomised 1,005 men with prostate cancer extending beyond the prostate after radical prostatectomy to 60 Gy of conventional postoperative irradiation over 6 weeks or to a wait-and-see policy until biochemical progression, defined as a PSA above 0.2 micrograms per litre confirmed twice at least 2 weeks apart. Median follow-up was 10.6 years, range 2 months to 16.6 years.
Postoperative irradiation significantly improved biochemical progression-free survival: 198 of 502 men (39.4 percent) against 311 of 503 (61.8 percent) had biochemical or clinical progression or died, hazard ratio 0.49 (95 percent confidence interval 0.41 to 0.59, p<0.0001).
The qualifications are as important as the result. Improvements in clinical progression-free survival were not maintained at 10 years. Late adverse effects of any type and any grade were more frequent after irradiation: 10-year cumulative incidence 70.8 percent (66.6 to 75.0) against 59.7 percent (55.3 to 64.1), p=0.001. Exploratory analyses suggested benefit in men under 70 and in those with positive surgical margins, and possible harm in men aged 70 or older.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,005 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Biochemical or clinical progression or deathprimary | Postoperative irradiation, 60 Gy | 502 | 39.4% | 0.49 (0.41 to 0.59) | <0.0001 | link |
| Wait and see | 503 | 61.8% | ||||
| Late adverse effects of any grade at 10 years | Postoperative irradiation, 60 Gy | 502 | 70.8% | - | 0.001 | link |
| Wait and see | 503 | 59.7% |
Shares ARTISTIC meta-analysis, RADICALS-RT, Biochemical recurrence (BCR), Radical prostatectomy.
Shares ARTISTIC meta-analysis, RADICALS-RT, Biochemical recurrence (BCR), Radical prostatectomy.
Shares Biochemical recurrence (BCR), Radical prostatectomy, Biochemical recurrence of prostate cancer, Localised prostate cancer, high and very high risk.
Shares RADICALS-RT, Radical prostatectomy, Biochemical recurrence of prostate cancer, Localised prostate cancer, high and very high risk.
Shares Biochemical recurrence (BCR), EORTC, Localised prostate cancer, high and very high risk, IMRT / IGRT (modern external beam).
Shares Biochemical recurrence (BCR), Radical prostatectomy, Biochemical recurrence of prostate cancer, IMRT / IGRT (modern external beam).
Shares Biochemical recurrence (BCR), Radical prostatectomy, Localised prostate cancer, high and very high risk, Prostate cancer.
Shares Biochemical recurrence (BCR), Localised prostate cancer, high and very high risk, IMRT / IGRT (modern external beam), Prostate cancer.